Polyarthritis as the Initial Presentation of Hyper Eosinophilic Syndrome

Area of Science:

• Hematology
• Rheumatology
• Internal Medicine

Background:

• Hyper eosinophilic syndrome (HES) is a rare hematologic disorder with significant morbidity and mortality risk if untreated.
• Atypical presentations of HES can lead to misdiagnosis and delayed management, underscoring the need for heightened clinical awareness.
• Early recognition and appropriate treatment are crucial for managing HES and preventing severe complications.

Observation:

• A 75-year-old female presented with fever and polyarthritis, initially suggestive of a rheumatologic condition.
• Joint fluid analysis revealed a high cell count with predominant neutrophils and eosinophils.
• Peripheral blood examination showed marked leukocytosis with significant eosinophilia (73% eosinophils).

Findings:

• Despite initial treatment with corticosteroids and hydroxycarbamide, the patient's condition worsened, with rising white blood cell counts and development of cardiac failure and neuropathy.
• Diagnosis of HES was confirmed after excluding eosinophilic leukemia.
• Imatinib therapy led to clinical stabilization, improvement in arthritis, and reduction in peripheral eosinophilia.

Implications:

• This case underscores the importance of considering HES in patients with unexplained polyarthritis and marked eosinophilia, even with atypical presentations.
• Imatinib may represent a viable therapeutic option for HES cases refractory to conventional corticosteroid therapy.
• Further research into optimal HES management strategies, particularly for steroid-resistant cases, is warranted.